Empirically Supported Use of Psychiatric Medications in Adolescents and Adults with IBD

Thorkelson, Gregory; Bielefeldt, Klaus; Szigethy, Eva

doi:10.1097/mib.0000000000000734

Cited by 30 publications

(22 citation statements)

References 245 publications

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“…Use of antidepressants improves the symptoms of depression and IBD at the same time 40,41 . In our study, we used an UC model induced by acetic acid 4%, to evaluate the effect of escitalopram in UC.…”

Section: Discussionmentioning

confidence: 99%

Effect of escitalopram on an acetic acid‐induced ulcerative colitis model

Firouzabadi

Alimoradi

Najafizadeh

et al. 2021

Clin Exp Pharma Physio

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Ulcerative colitis (UC) is a chronic and recurrent gastrointestinal (GI) disorder with an unknown aetiology and pathogenesis. Regarding the effectiveness of antidepressants on UC in animal models of depression and the known anti‐inflammatory effects of escitalopram this study was conducted to evaluate the beneficial effects of escitalopram on an acetic acid‐induced UC model without depression. UC model was induced by intra rectal (i.r.) administration of 4% acetic acid in rats after 24 hours of fasting. Animals were treated with three doses of escitalopram (5, 10 and 20 mg/kg). Prednisolone (4 mg/kg) was used as a reference drug in UC. Histological and oxidative stress markers were measured in all groups. Results showed significant increase in superoxide dismutase (SOD) activity and glutathione (GSH) levels, as well as significant decrease in myeloperoxidase (MPO) activity, malondialdehyde (MDA) levels, macroscopic factors (ulcer surface area, ulcer severity and weight‐to‐colon ratio) and microscopic and histological parameters (severity and extent of inflammation, cryptic destruction and severity of tissue involvement) in escitalopram treated rats (10, 20 mg/kg) compared to the UC group. In conclusion, the results of our study are in support of beneficial anti‐inflammatory and antioxidant effects of escitalopram in UC.

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Section: Discussionmentioning

confidence: 99%

Effect of escitalopram on an acetic acid‐induced ulcerative colitis model

Firouzabadi

Alimoradi

Najafizadeh

et al. 2021

Clin Exp Pharma Physio

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“…Although developed for patients with NBS, this detoxification approach can be useful for moving from opioid to non-opioid pain management strategies for other patients with chronic abdominal pain, such as those with IBS, IBD or chronic pancreatitis. TCAs can improve the global symptoms of IBS 113 , and the noradrenergic modulatory action of TCAs might have anti-inflammatory effects 114 and might also inhibit TLR4 and TLR2 activation 94 . These TCA-linked pathways might also be beneficial for patients with IBD 115 .…”

Section: Prevention and Treatment Considerationsmentioning

confidence: 99%

“…Anticonvulsant medications such as gabapentin and pregabalin have shown efficacy in reducing pain in patients with pancreatitis, IBS or IBD, mediated via effects in the brain 122–126 . Several review articles published elsewhere cover the risks and benefits of using other psychotropic agents for the management of abdominal pain 81,87,114,127,128 . TABLE 1 summarizes the empirical evidence for the use of psychotropic agents for chronic abdominal pain 113,116,129–133 ; however, the findings of these meta-analyses should be interpreted in light of several general limitations, including overlap of included studies, small sample sizes, diversity of medications within each drug class, lack of uniformity of study endpoints and substantial heterogeneity among the studies analysed.…”

Section: Prevention and Treatment Considerationsmentioning

confidence: 99%

Opioid misuse in gastroenterology and non-opioid management of abdominal pain

Szigethy

Knisely

Drossman

2017

Nat Rev Gastroenterol Hepatol

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Opioids were one of the earliest classes of medications used for pain across a variety of conditions, but morbidity and mortality have been increasingly associated with their chronic use. Despite these negative consequences, chronic opioid use is increasing worldwide, with the USA and Canada having the highest rates. Chronic opioid use for noncancer pain can have particularly negative effects in the gastrointestinal and central nervous systems, including opioid-induced constipation, narcotic bowel syndrome, worsening psychopathology and addiction. This Review summarizes the evidence of opioid misuse in gastroenterology, including the lack of evidence of a benefit from these drugs, as well as the risk of harm and negative consequences of opioid use relative to the brain-gut axis. Guidelines for opioid management and alternative pharmacological and nonpharmacological strategies for pain management in patients with gastrointestinal disorders are also discussed. As chronic pain is complex and involves emotional and social factors, a multimodal approach targeting both pain intensity and quality of life is best.

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“…Cognitive behavioural therapy has been found to improve symptoms of depression and quality of life among IBD patients . Pharmacological therapy in the form of selective serotonin reuptake inhibitors and tricyclic antidepressants has improved psychiatric symptoms, quality of life and IBD disease activity . Given the existence of effective treatments with the potential for significant clinical and psychological impact, interventions targeting screening and treatment for anxiety and depression at both the preoperative and postoperative surgical visits may be of significant clinical utility.…”

Section: Discussionmentioning

confidence: 99%

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients

et al. 2019

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Aim Patients with inflammatory bowel disease (IBD) are diagnosed with anxiety/depression at higher rates than the general population. We aimed to determine the frequency of anxiety/depression among IBD patients and the temporal association with abdominal surgery and stoma formation. MethodWe conducted a retrospective cohort study in adult patients with IBD using difference-in-difference methodology and a large commercial claims database (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). Outcomes were anxiety/depression diagnoses before and after major abdominal surgery or stoma formation. ResultsWe identified 10 481 IBD patients who underwent major abdominal surgery, 18.8% of whom underwent stoma formation, and 41 924 nonsurgical age-and sexmatched IBD controls who were assigned random index dates. Rates of anxiety and depression increased among all cohorts (P < 0.001). Surgical patients had higher odds of anxiety [one surgery, adjusted OR 6.90 (95% CI 6.11-7.79), P < 0.001; two or more surgeries, 7.53 (5.99-9.46), P < 0.001] and depression [one surgery, 6.15 (5.57-6.80), P < 0.001; two or more surgeries, 6.88 (5.66-8.36), P < 0.001] than nonsurgical controls. Undergoing multiple surgeries was associated with a significant increase in depression from 'pre' to 'post' time periods [1.43 (1.18-1.73), P < 0.001]. Amongst surgical patients, stoma formation was independently associated with anxiety [1.40 (1.17-1.68), P < 0.001] and depression [1.23 (1.05-1.45), P = 0.01]. New ostomates experienced a greater increase in postoperative anxiety [1.24 (1.05-1.47), P = 0.01] and depression [1.19 (1.03-1.45), P = 0.01] than other surgical patients.Conclusion IBD patients who undergo surgery have higher rates of anxiety and depression than nonsurgical patients. Rates of anxiety and depression increase following surgery. Stoma formation represents an additional risk factor. These findings suggest the need for perioperative psychosocial support services. Keywords Stomas, depression, anxiety, inflammatory bowel diseaseWhat does this paper add to the literature? The relationship between surgery for inflammatory bowel disease, stoma formation, and anxiety and depression has been poorly quantified. We found that surgery for inflammatory bowel disease increased rates of anxiety and depression. Multiple surgeries and stoma-forming surgeries placed patients at additional risk. This suggests the need for additional psychosocial support services for these high-risk patients.

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Empirically Supported Use of Psychiatric Medications in Adolescents and Adults with IBD

Cited by 30 publications

References 245 publications

Effect of escitalopram on an acetic acid‐induced ulcerative colitis model

Effect of escitalopram on an acetic acid‐induced ulcerative colitis model

Opioid misuse in gastroenterology and non-opioid management of abdominal pain

Surgery, stomas, and anxiety and depression in inflammatory bowel disease: a retrospective cohort analysis of privately insured patients

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